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The predicted clinical workload associated with early post‐term surveillance and inductions of labour in south Asian women in a non‐tertiary hospital setting
Author(s) -
Green Brittany,
Howat Paul,
Hui Lisa
Publication year - 2021
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.13268
Subject(s) - medicine , gestation , singleton , obstetrics , fetus , pregnancy , tertiary level , pediatrics , mathematics education , mathematics , genetics , biology
Background Stillbirth increases steeply after 42 weeks gestation; hence, induction of labour (IOL) is recommended after 41 weeks. Recent Victorian data demonstrate that term stillbirth risk rises at an earlier gestation in south Asian mothers (SAM). Aims To determine the impact on a non‐tertiary hospital in Melbourne, Australia, if post‐dates IOL were recommended one week earlier at 40 + 3 for SAM; and to calculate the proportion of infants with birthweight < 3rd centile that were undelivered by 40 weeks in SAM and non‐SAM, as these cases may represent undetected fetal growth restriction. Materials and Methods Singleton births ≥ 37 weeks during 2017–18 were extracted from the hospital Birthing Outcomes System. Obstetric and neonatal outcomes for pregnancies that birthed after spontaneous onset of labour or IOL were analysed according to gestation and country of birth. Results There were 5408 births included, and 24.9% were born to SAM ( n = 1345). SAM women had a higher rate of IOL ≥ 37 weeks compared with non‐SAM women (42.5% vs 35.0%, P < 0.001). If all SAM accepted an offer of IOL at 40 + 3, there would be an additional 80 term inductions over two years. There was no significant difference in babies < 3rd centile undelivered by 40 weeks in SAM compared with non‐SAM (29.6% vs 37.7%, P = 0.42). Conclusions Earlier IOL for post‐term SAM would only modestly increase the demand on birthing services, due to pre‐existing high rates of IOL. Our current practices appear to capture the majority at highest risk of stillbirth in our SAM population.